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M-spike in urine, no m-spike in serum?
Family member was diagnosed and treated for multiple myeloma 3 years ago. They achieved an sCR. The latest test struck me as odd. It found an m-spike of 0.4 by electrophoresis in the urine. But, no m-spike was present in the serum by electrophoresis. In addition, their serum free light chains were normal and so was the ratio. All IGs are also normal. It's my understanding that an m-spike is only found in the urine when it exceeds a certain threshold in the serum and "spills over" into the urine. Please help!
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Perseverance - When were you/they diagnosed?: 2010
Re: M-spike in urine, no m-spike in serum?
Hi, I am light chain only so I am used to negative SPEP's (electropheresis). It is the least sensitive of the various tests and will not pick up light chains. Next is serum IFE....was serum immunofixation done? Was that negative? Next more sensitive is the UPEP which you say was positive. Only a doctor can explain everything, but I think it may be the degree of sensitivity of the tests.
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: M-spike in urine, no m-spike in serum?
With a normal serum protein electrophoresis and serum free light chains, it is surprising that the urine result is abnormal. I agree with getting the immunofixation on serum. If that is normal, you may be dealing with a false positive test, in which case repeating the urine tests would be warranted. Let us know the outcome. Thanks!
Pete V.
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: M-spike in urine, no m-spike in serum?
The doctor has recommended a bone marrow biopsy before anything else is done. The free light chains and ratio in serum still remain in the normal range. IGA is also in the normal range. Creatinine is good at .60; HGB is good at 15.7; WBC is good at 4.8; calcium is not elevated; A/G ratio is normal.
The eletrophoresis and immunofixation were not repeated, but I will restate the results from last month:
Serum: no monoclonal band noted.
Urine: m-spike of 0.4 noted confirmed as kappa type via immunofixation
Of all of the research I read, the consensus is that urine tests are not even necessary in light of the sensitivity of serum free light chain measurements. One article by Lancet examined 600 patients with suspected light chain myeloma. Not a single patient with Bence Jones protein in their urine had a normal free light chain ratio.
In light of these studies, most researchers agree that urine tests are superfluous for the monitoring of myeloma so long as the free light chain test is done.
The m-protein in the urine has me perplexed.
Any thoughts would be appreciated. Also, will the bone marrow biopsy give a definitive answer as to what, if anything, is going on?
The eletrophoresis and immunofixation were not repeated, but I will restate the results from last month:
Serum: no monoclonal band noted.
Urine: m-spike of 0.4 noted confirmed as kappa type via immunofixation
Of all of the research I read, the consensus is that urine tests are not even necessary in light of the sensitivity of serum free light chain measurements. One article by Lancet examined 600 patients with suspected light chain myeloma. Not a single patient with Bence Jones protein in their urine had a normal free light chain ratio.
In light of these studies, most researchers agree that urine tests are superfluous for the monitoring of myeloma so long as the free light chain test is done.
The m-protein in the urine has me perplexed.
Any thoughts would be appreciated. Also, will the bone marrow biopsy give a definitive answer as to what, if anything, is going on?
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Perseverance - When were you/they diagnosed?: 2010
Re: M-spike in urine, no m-spike in serum?
Hi, the BMB is the gold standard when dealing with plasma cell disorders. However, as Dr. Voorhees outlined above, perhaps it is a false positive. Why won't the doctor simply re-run the test?
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: M-spike in urine, no m-spike in serum?
terryl1 wrote:
> Hi, the BMB is the gold standard when dealing with plasma cell disorders.
> However, as Dr. Voorhees outlined above, perhaps it is a false positive.
> Why won't the doctor simply re-run the test?
For whatever reason, this is the way he wants to do it. My question is: on the BMB what will they be looking for to either rule out or confirm a relapse? Is it as simple as looking for >10% plasma cells? What criteria will inform whether this is classified as a relapse needing treatment, a wait-and-see situation, or a confirmation that the UPEP was a false positive? Thanks.
> Hi, the BMB is the gold standard when dealing with plasma cell disorders.
> However, as Dr. Voorhees outlined above, perhaps it is a false positive.
> Why won't the doctor simply re-run the test?
For whatever reason, this is the way he wants to do it. My question is: on the BMB what will they be looking for to either rule out or confirm a relapse? Is it as simple as looking for >10% plasma cells? What criteria will inform whether this is classified as a relapse needing treatment, a wait-and-see situation, or a confirmation that the UPEP was a false positive? Thanks.
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Perseverance - When were you/they diagnosed?: 2010
Re: M-spike in urine, no m-spike in serum?
I assume they will compare the results with your family member's previous results when he/she achieved sCR....PC less than 5%, etc. They will also do flow cytometry to look for MRD (minimal residual disease). I would imagine they will also want to do a PET CT contemporaneously to see if the marrow and bones show any uptake or lesions.
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: M-spike in urine, no m-spike in serum?
Hello Again,
As you may remember, earlier in this thread I detailed an odd occurrence: No M-Spike in serum, normal FLC ratio, but an m-spike of .4 in urine. This was the first test showing anything since acheiving an sCR three years ago. Some of you suggested that a bone marrow biopsy would be informative. The results are as follows:
"Bone Marrow Morphology: Plasma cells comprise 4% of overall bone marrow cellularity.
Cytogenetics: A normal female karyotype was observed.
Flow Cytometry: Percentage of abnormal cells: .06% ; Viability 7AAD: 99%
Note: A monoclonal IGA kappa plasma cell (CD38 bright) population is present."
There are other specific number breakdowns on the results, if needed I can provide them.
Please share your thoughts on what these results mean in our particular case.
As you may remember, earlier in this thread I detailed an odd occurrence: No M-Spike in serum, normal FLC ratio, but an m-spike of .4 in urine. This was the first test showing anything since acheiving an sCR three years ago. Some of you suggested that a bone marrow biopsy would be informative. The results are as follows:
"Bone Marrow Morphology: Plasma cells comprise 4% of overall bone marrow cellularity.
Cytogenetics: A normal female karyotype was observed.
Flow Cytometry: Percentage of abnormal cells: .06% ; Viability 7AAD: 99%
Note: A monoclonal IGA kappa plasma cell (CD38 bright) population is present."
There are other specific number breakdowns on the results, if needed I can provide them.
Please share your thoughts on what these results mean in our particular case.
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Perseverance - When were you/they diagnosed?: 2010
Re: M-spike in urine, no m-spike in serum?
Your relative is MRD (minimal residual disease) positive as opposed to MRD negative. Important---This doesn't mean your relative is relapsing. It means he/she has a very low, low, low monoclonal population present. In myeloma, the concept of MRD is still evolving, unlike in other blood cancers. Check out the International Myeloma Foundation's site and follow the link to the Black Swan Initiative....it will explain MRD and what they are trying to do with it in terms of defining cure in myeloma.
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terryl1 - Name: Terry
- Who do you know with myeloma?: self
- When were you/they diagnosed?: August 10, 2011
- Age at diagnosis: 49
Re: M-spike in urine, no m-spike in serum?
We have an appointment next week to review these results. I'm wondering if anyone has an opinion on whether or not treatment is needed at this time.
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Perseverance - When were you/they diagnosed?: 2010
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